Program Description: This webinar is designed for physicians and will cover the Coordinated Care Initiative (CCI) and the programs within the initiative including Cal MediConnect, known as OneCare Connect in Orange County.

The CCI is a new program designed to help provide extra support for low-income seniors and people with disabilities in California, including those who are dually eligible for Medicare and Medi-Cal.

Webinar topics include:

1. Overview: How the CCI is changing health care for dual eligible patients;

2. Continuity of Care: How to keep seeing your patients if they join OneCare Connect;

3. Care Coordination: How OneCare Connect can help support physicians in coordinating care for patients, including in-home and community based services;

4. Billing Processes: How billing works under the CCI for patients who join OneCare Connect and for those who remain in fee-for-service Medicare and join the CCI for Medi-Cal services.

July 1, 2016 is the deadline for mandatory CURES registration for all physicians with an active medical license and a Drug Enforcement Agency certificate. In order to help prepare physicians, CMA hosted a webinar on the CURES 2.0 registration process, which was presented by the Department of Justice. The webinar is now available on-demand in the CMA Resource Library and is free for both members and non-members. Please click here to view the CURES 2.0 webinar

Governor Jerry Brown appointed Dr. Nikan Khatibi to the Board of Trustees for the California Health Professions Education Foundation (CHPEF). Established in 1987, the CHPEF is the state's only non-profit foundation statutorily created to improves access to healthcare in underserved areas of California. The Board has awarded more than $124,000,000 in scholarships and loan repayments to California health professionals who are dedicated to providing direct patient care in those key areas. By doing so, the Board has provided California patients with a culturally and linguistically competent health workforce dedicated to delivering direct patient care in California's underserved communities. Dr. Khatibi is a physician anesthesiologist, pain medicine and addiction specialist. He currently resides in Orange County, California.

November 11-22, 2015
This past November, under the umbrella of Arpan Global Charities CHOC and SJO doctors traveled to Nepal to exchange information and share their skills and time at the Kathmandu University Hospital in Dhulikhel, Nepal, an independent, non-profit teaching hospital. Opened in 1996, the hospital, besides health services, also provides medical, dental and nursing schools, in collaboration with Kathmandu University.

The devastation from the 7.8 earthquake that killed 9,000 people and destroyed the area’s infrastructure in April 2015 was quite visible. The current fuel crisis was also evident causing the hospital to cook meals for patients and staff outdoors with wood.

Before the trip, some of the Dhulikhel surgeons requested needed supplies. SJO Interim Chief Medical Officer and orthopedic surgeon Paul Beck, MD, who made the trip along with his wife, internist Huong Thi Duong, MD, cited arthroscopy shavers used to trim tissue in the knee as an example. “In the US we use these blades once but in Nepal they were reused and sterilized dozens of times and were quite dull.” He has contacted a supplier in the US who will be donating new blades, although after the trip.

SJO NICU Medical Director and the founder of Arpan Global Charities, Sudeep Kurkreja, MD, and his wife, Song Kukreja, helped organize and participated in the trip. This Mission Dhulikel , Nepal was the 18th volunteer medical mission organized by Arpan Global Charities and was tremendously successful. During this mission focus was more on teaching and education than service, although our team members examined and treated more than 300 patients and performed 65 surgical and dental procedures. Every single day each team members gave 2-3 didactic lectures to their respective counterparts from Nepal as well as hands on demonstration of latest surgical procedures and skills.

He continues, “There is great need for exchange of knowledge and skills between the physicians and surgeons from US and Nepal.” Dr. Ram Shrestha, the Vice Chancellor at Katmandu University Hospital in Dhulikhel, was very supportive of having an ongoing academic affiliation between Dhulikhel Hospital and SJH/CHOC. We discussed at great length about developing exchange program between Kathmandu University Hospital in Dhulikhel and SJH/CHOC especially in the area of neonatology and pediatric surgery. SJH President and CEO Steve Moreau, who was part of this mission with his wife Anne, will be working with CHOC to facilitate this exchange.

Also on the Nepal mission trip were anesthesiologist Jeffrey Sycamore, MD; dentist Vazrick Navasartian; pediatric infectious disease subspecialist Jasjit Singh, MD and her husband pediatric ENT Gurpreet Ahuja, MD; ophthalmologist David Yomtoob MD, and his wife Allison; pediatric nephrologist Dorit Ben-Ezer, MD and her daughter Maya; Hillary Nguyen, a SJO volunteer and Cal State Fullerton student; CHOC neonatal nurse Cindy Hecklau. All the volunteers paid for their own flight, meals, and accommodations at a lodge about a kilometer from the hospital.

This mission was not possible without contribution by each and every one of the volunteers and our host team members at the Kathmandu University Hospital, Dhulikhel.

- The Annual Meeting of the American Society of Clinical Oncology (ASCO) provides an opportunity for thousands of oncologists and health care professionals
to receive research updates and exchange ideas surrounding trends in cancer treatments.

More than 30,000 attend each year, making it one of the largest educational and scientific conferences dedicated to advancing cancer care. I recently
joined my colleagues for the ASCO 2015 Annual Meeting, where a focus was on breakthroughs in immunotherapy.

What is Immunotherapy?

Immunotherapy refers to treatments that prompt the human body’s immune system to attack cancer cells. Cancer occurs when a genetic mutations occurs that
causes a healthy cell to become cancerous. Can the immune system recognize these cancerous cells as harmful or are they too at home within the body?

Recently, we have determined that the immune system often does recognize cancerous cells. The immune system produces white blood cells called lymphocytes
that target harmful substances, called antigens, within the body. In response to the development of some cancers, lymphocytes will gather around cancerous
cells. However, they do not always infiltrate cancerous cells and cause them to die.

Some cancers produce certain proteins, such as programmed cell death 1 (PD1). These are similar to other naturally-occurring proteins that prevent the
immune system from interrupting certain normal biological functions. For instance, these proteins prevent the body from rejecting a fetus during pregnancy.
When a cancer cell produces PD1, it sends a message to lymphocytes to back off.

A relatively new class of drugs called PD1-inhibitors prevents cancer cells from disguising themselves as healthy cells. Several ASCO 2015 Annual Meeting
presentations on PD1-inhibitors revealed that they were an effective treatment for several cancers.

Pembrolizumab –
More than one-half of patients with advanced head and neck cancer experienced noticeable decrease in size of tumors following treatment with
pembrolizumab.

Nivolumab –
Tumors ceased growing in approximately one-half of patients with advanced liver cancer treated with nivolumab. Advanced lung cancer patients treated
with nivolumab lived an average of three months longer than patients treated with docetaxel, a chemotherapy.

Immunotherapy in Breast Cancer Patients

Ongoing research is also investigating the use of PD1-inhibitors in breast cancer patients. In an early stage trial, 4 of 21 triple-negative breast cancer
patients with the PD1 protein responded to a PD1-inhibitor currently under investigation. These results prompted the FDA to assign the drug, MPDL3280A,
Breakthrough Therapy Designation, which is reserved for treatments that appear significantly more effective in clinical trials than existing treatments.

In an upcoming phase III trial sponsored by drug maker Hoffman-La Roche, researchers will investigate the use of MPDL3280A in combination with
nab-paclitaxel, a type of chemotherapy, in patients with metastatic breast cancer. The phase III trial is currently recruiting patients. Eligible
candidates include women with advanced triple-negative breast cancer with no prior chemotherapy or targeted systemic therapy for inoperable disease.

Breastlink will work with researchers as a clinical partner in ongoing MPDL3280A research. This means patients eligible to participate in the study can
receive MPDL3280A at Breastlink locations in Orange County. At this time, Breastlink locations are the only sites in Orange County and Los Angeles County
where patients can participate in this study. As part of our commitment to advancing innovative breast cancer therapies, Breastlink is excited to play a
role in ongoing research and to offer patients an opportunity to participate.

One drug already approved by the FDA for breast cancer patients combines immunotherapy with conventional chemotherapy. Ado-trastuzumab emtansine ( T-DM1) uses an antibody called trastuzumab to target receptors
present on cancerous cells in women with HER2-positive breast cancer. Once T-DM1 has bound to HER2 receptors, a chemotherapy agent called DM1 is delivered
to the interior of cancerous cells, destroying them from the inside.

There are several benefits to immunotherapy over conventional chemotherapy and other targeted treatments. Researchers are continuing to produce evidence that immunotherapy
improves clinical outcomes compared with conventional chemotherapy. Additionally, patients generally experience fewer side effects when treated.
Immunotherapy also allows the immune system to develop a lasting memory of the antigen – in this instance, a type of cancer cell. If this specific type of
cancer recurs, the immune system will continue to respond.

Developments such as those presented provide hope for a cure. The scientific and medical communities recognize new immunotherapy agents as huge
breakthroughs. With these drugs, we can avoid treating more women with chemotherapy while improving their outcomes. At Breastlink, we are excited by these
advancements and will eagerly track updates as they occur.

In this issue of the In+Care newsletter, we are going to discuss the Medi-Cal renewal process and some key things that may help your client(s) with their Medi-Cal redetermination packet. In Orange County, Medi-Cal is also called CalOptima.

What is Medi-Cal redetermination?

Medi-Cal recipients must have their eligibility assessed and verified every 12 months1. This process is to make sure clients are still eligible to receive Medi-Cal benefits. This process is different from Ryan White eligibility screening. If someone is receiving Ryan White services, they must continue to be screened for Ryan White eligibility every 6 months.

What will happen and what must be done?

Beginning in 2015, Medi-Cal will do a prescreening of recipients’ files to see if they are still eligible to receive services under Medi-Cal1. Clients may have received a Request for Tax Household Information (RFTHI) that must be completed for Medi-Cal to gain access to income information. If the information show that the individual is still eligible to receive Medi-Cal, their eligibility will automatically renew. Clients will receive a letter that states they are renewed for another year1. This means that they will not need to submit any information to continue being eligible for Medi-Cal.

However, if current or updated information is needed, a redetermination packet will be sent to the client asking for specific documents. Information needed is on a case-by-case basis1.

My client does not have a stable address, how can they complete the redetermination process?

Clients can call (800) 281-9799 or visit any Social Services Agency office (listed at the end of the newsletter) to complete the process.

My client received a redetermination packet, what are they supposed to do with it?

If the client receives a redetermination packet, provide all the required information before the due date indicated in the packet.

My client does not have a stable address or the address on file is wrong; what should they do?

Individuals can call (800) 281-9799 to see if they need to complete the redetermination process. If so, they can go to a Medi-Cal office (locations listed at the end of the newsletter) and find out what you need to do to get or keep coverage. If they need to update their address, they can call (800) 281-9799.

If my client has questions about the requested information who should they contact?

If there are questions, clients can contact their Medi-Cal worker or the contact person indicated in the redetermination packet.

Clients can also contact (800) 281-9799 for general Medi-Cal coverage questions.

When do clients have to return the completed redetermination packet?

The redetermination packet should have the due date when and all of the requested information must be provided. Make sure you do this as soon as possible before the due date.

What if clients do not submit their documents on time?

Medi-Cal benefits will be stopped. Clients will receive a Notice of Action that explains why their benefits have been stopped1.

The Notice of Action will also state that they have 90 days from the date of the Notice of Action, also called a “cure period”, to provide requested information2.

If the client provides the requested information within the 90 days after the notice, their benefits may be reinstated and there should be no break in Medi-Cal coverage. However, there may be delays in benefit claims if they are reinstated during the 90 day period.

If clients do not provide the information or the information submitted is not acceptable, their benefits will be stopped and they will have to reapply for Medi-Cal.

Can my client get ADAP for their medications if they are in the 90-day “cure” period?

No. Currently, ADAP guidelines states that clients cannot receive ADAP during the 90-day period. If clients receive a denial letter from Medi-Cal, they can apply to receive ADAP services with a Ryan White eligibility worker.

Can my client get Ryan White medical care if they are in the 90-day “cure” period?

No. Ryan White services are provided as payer of last resort. In order to receive Ryan White medical care a denial letter from Medi-Cal would be needed.

Should my client apply for Ryan White if they have Medi-Cal?

Yes. Ryan White covers services that are not covered by Medi-Cal (for example, food pantry, housing services, or legal services). Ryan White covers services that are partially covered by Medi-Cal (for example dental care). It is important to be screened for Ryan White eligibility to ensure they can access all the services they need and are eligible to receive.

Reminders:

Call (800) 281-9799 for Medi-Cal questions.

Clients should check and open your mail!

If clients change their address, they should let their Medi-Cal worker know.

If clients received a redetermination packet, they should provide the requested information as soon as possible to prevent a loss in coverage.

This year marks 20 years Breastlink has helped patients with their breast health needs. As I reflect back upon our history I have never felt more strongly
that our comprehensive, multidisciplinary approach to treat breast cancer best serves women.

I also believe, thanks to clinical research, we are on the cusp of discovering a real cure for many types of breast cancer in the next decade. Research has
begun to reveal the genomic differences in cancer cells. This will lead to new, “targeted” agents that will significantly improve treatment options.
Breastlink, through our work with the Cancer Research Collaboration, is involved in many of the
promising clinical trials.

However, the reality persists that far too many women succumb to this truly horrible malady. Before we look to the future, I have outlined the history and
progress of our practice.

History of Breastlink

In the 1970s, attitudes toward breast cancer treatment began to change for the better. Radical mastectomy had been the preferred method for treating breast
cancer since the late 19th century. This procedure called for the complete removal of all breast tissue, the nipple, lymph nodes in the armpit,
and muscles lining the chest wall beneath the breast.

During this time, women were rarely consulted about treatment. Some even awoke from sedation to find that the decision to remove their breasts had already
been made for them.

The move toward a more individualized treatment approach was welcome. It became increasingly apparent that there were equally effective, more
patient-friendly alternatives to radical mastectomy. As this occurred, more women refused the one-size-fits-all breast cancer treatment.

In 1979, the National Institutes of Health issued a statement declaring that surgery to treat breast cancer should preserve as much muscle tissue as
possible. They also indicated radiation therapy could be administered as a primary treatment with limited surgery.

More importantly, the consensus statement recognized that a preoperative needle biopsy should be performed “before definitive therapeutic alternatives are
discussed with the patient.”Physicians were finally beginning to realize that women should have a say in their treatment.

Inspired by the voices of women calling for a greater role in their treatment, as well as growing enthusiasm for the development of new and better ways to
prevent, I helped to found one of the nation’s first comprehensive breast cancer treatment centers in 1985.

Helping to develop the breast cancer treatment center at the Long Beach Medical Center was an invaluable experience that would inform my decision-making
when I set out to establish Breastlink.

Founded in 1995 as a single, outpatient facility in Long Beach, Breastlink has grown into a network of three outpatient breast cancer treatment centers.
These centers offer women a multidisciplinary medical team and comprehensive services aimed at breast cancer screening, diagnosis, treatment and follow-up.

A Comprehensive Breast Cancer Care Model

A comprehensive breast cancer care model provides access to a coordinated team of multiple physicians practicing across different specialties. Using this
model, a woman can have all of her breast cancer screening or treatment needs attended to by a single team working under the same roof.

As medicine has become increasingly specialized and new knowledge revealed how individual cancers behave differently, more and more types of physicians are
included in breast cancer treatment. A breast cancer treatment team should include at least four or five different specialists, including:

Most physicians are inclined to practice what they know. For instance, a surgeon will most likely be inclined to believe that surgery is the best available
treatment option. This is partly why radical mastectomy remained the standard of care for so long.

However, a multidisciplinary team working together can help physicians to look past professional biases. When we work together with each other and
patients, the result is more appropriate treatment.

A comprehensive breast health care treatment model works most effectively when women are placed in a partnership with their physicians. The goal is to
provide individualized care that is neither over-nor under-treated. Treatment should offer the best chance for survival with as few side effects as
possible. Physicians can optimize treatment outcomes by offering a combination of education, compassion, communication and experience.

Providing comprehensive breast cancer treatment means treating the whole woman, not necessarily just the disease. Treatment must be compatible with women’s
own beliefs and philosophies. Breastlink helps to accomplish this by providing numerous resources under one roof.

This includes physicians, nurses, researchers, medical assistants, psychotherapists and nutritionists. Each member of this treatment team, those seen and
unseen, contribute to healing as defined by the woman being treated.

Looking Toward the Future of Targeted Therapies

Breast cancer is the result of gene mutations. Some mutations cause cells to achieve additional function, allowing them to grow out of control, or to
become drug resistant and to spread to other parts of the body. Other mutations can cause cells to lose their function, which creates susceptibility to
cancer.

Not all breast cancers are created equal. The underlying gene mutation that allowed cancer to begin growing will also dictate how that cancer behaves as it
grows.

Growing knowledge of the relationship between gene mutations and breast cancers has led to the potential for evermore individualized treatments. For
instance, in approximately 20 percent of cancers, a protein known as HER2
is present on the surface of cancerous cells. When this protein is present, cancers tend to grow especially quickly and aggressively.

To combat HER2-positive cancers, researchers and pharmaceutical makers have investigated drugs that specifically target this protein. Herceptin, introduced
in the late 1980s, was one of the first of these targeted drugs to be developed. Herceptin can attach itself to HER2 proteins to slow cancer growth and
promote chemotherapy response. We now have a number of anti-HER2 agents that target this type of breast cancer.

Herceptin is just one example of many targeted therapies, either on the market or being investigated. Targeted therapies are designed to attack a specific
genetic mutation of the breast cancer.

It is important for women to learn about their individual cancer, as well as emerging treatment options and targeted therapies, to make an informed decision about treatment. Breastlink has been proud to participate in
the research into these targeted therapies and to maintain up-to-date knowledge of ongoing research. This allows us to provide women the information they
need to make a decision customized to their priorities and their disease.

Many gains have been made in our understanding of breast cancer over the past twenty years. Women have benefitted from advancements in prevention,
screening and treatment. Research exploring new treatments and interventions show potential for continued improvement in breast health care.

A big part of what we do is clinical research. Over the next few years, we will expand our participation in research to help women have access to or
receive therapies still under investigation.

Breastlink has worked with researchers for many years to improve access for patients to new drugs or therapies currently under investigation. Through a
partnership with Cancer Research Collaboration, a non-profit organization, we are able to continue to
offer our patients a robust opportunity to participate in the development of new agents and new tests.

This also provides researchers access to a team of clinical investigators with strong research backgrounds who can help to identify breast cancer patients that are qualified candidates
for research projects. We believe partnerships such as these can improve process for delivery and approval of effective cancer therapies, and add to our
collective knowledge of cancer. We strive for a future without breast cancer research moves us closer to this future.

I wish to thank my co-workers, colleagues, the community and, most of all, our patients for their support. Without you all Breastlink
would not be possible. We look forward to working with you over the next 20 years and beyond to improve breast cancer care.

About Breastlink and Dr. John Link

John Link, MD is the founder of Breastlink and a leading medical oncologist dedicated to the care of women with breast cancer. To learn more about Dr. Link
and Breastlink please visit Breastlink.com.

During the May 2015 OCMA General Membership Meeting, Eric G. Handler, M.D. was named the 2015 OCMA Physician of the Year. The Orange County Register Coast Magazine put a spotlight on Dr. Handler’s achievement in their July issue. Click here or on the link below and scroll through to page 135 to read more about Dr. Handler.